Aims: Preconception planning is an essential component of improving maternal and child health, particularly for individuals with mental health conditions. Within this population those with severe and enduring mental illnesses face significant barriers to accessing preconception care and are at higher risk of unplanned pregnancy, leading to suboptimal outcomes for both mothers and babies. This poster outlines the establishment of a preconception planning clinic for individuals within a mental health rehabilitation setting, developed through a collaborative initiative between the Rehabilitation and Recovery Service, Perinatal Mental Health Service, All Wales Psychiatric Genomics Service and Sexual Health services.

The clinic aims to provide personalised, multidisciplinary support to women with severe and enduring mental health conditions who are of childbearing age, ensuring that their mental health, medical, and social needs are addressed in a holistic and coordinated manner. Key components include individualised care planning, medication review, counselling on genetic risk to the baby, and psychosocial support, as well as the provision of education on reproductive health, contraception, and healthy relationships. Risks and impact to both mother and baby will be central to all discussions.

Methods: Through close collaboration between the Rehabilitation and Recovery Service, Perinatal Mental Health Service, All Wales Psychiatric Genomics Service and Sexual Health services, the clinic will foster an integrated approach to care, promoting early intervention and prevention of adverse outcomes. This initiative also supports service users in navigating the complexities of mental health during pregnancy, enhancing their confidence in planning for a safe and supported conception.

Results: The hope is that this clinic will promote proactive discussion of reproduction and sexual health within a population that have historically been overlooked in this aspect and reduce associated stigma and inequity.

Conclusion: The poster will showcase the clinic’s design, key challenges encountered, strategies for team integration, and initial outcomes from service users, with the aim of providing a model for other settings seeking to improve preconception care for individuals with severe and enduring mental illness.

Aims: Dopamine agonists are prescribed to treat several major physical and mental illnesses. Rotigotine, ropinerole, pramipexole (full agonists) are routinely used to treat symptoms of restless leg syndrome, whilst aripiprazole (partial agonist) is used as both an antipsychotic and mood stabiliser.

There is significant co-morbidity between gambling disorder and those psychiatric presentations resulting in the prescribing of aripiprazole. Full and partial dopamine agonists are known to increase the risk of de-novo gambling disorder, and exacerbation of existing gambling disorder. The aims of the audit were thus as follows:

To ensure that 100% of initial assessments include a full medication history, comprising current dopamine agonist (full or partial) prescribing history and indication for prescribing.

To ensure that 100% of patients identified at referral as prescribed dopamine agonists are screened by a psychiatrist within the service prior to allocation to the appropriate gambling disorder treatment pathway.

Methods: 402 initial assessments were carried out in the service in 2023. A random sample of 30 was selected using a random number generator and the initial assessments extracted from the Trust electronic record system (Care Director). Initial assessments were screened by a CT3 doctor to ascertain if a complete drug history was documented. The presence of dopamine agonist prescribing was noted including the drug name. Where dopamine agonists were prescribed, medical records were referenced to check if a screen was conducted by a psychiatrist.

Results: 53% (16/30) of the sample had a full drug history documented. 17% (5/30) of the sample were prescribed a dopamine agonist and in all cases, this was aripiprazole. Of the 5 patients in the sample prescribed aripiprazole, only 1 was documented as being referred for screening by a psychiatrist prior to commencement of psychological treatment for gambling disorder.

Conclusion: 53% of records sampled had a full drug history documented, suggesting that there are further patients who were prescribed dopamine agonists at the point of initial assessment that the service was unaware of. Of the 17% of the sample that were prescribed dopamine agonists, all cases were aripiprazole. This highlights the significant psychiatric co-morbidity and the importance of screening by a psychiatrist to exclude the dopamine agonist as a causative factor in the presentation.

Further staff training on the clinical importance of dopamine agonists in this context, ensuring 100% of initial assessments include a complete drug history, and discussion with a psychiatrist where appropriate are recommended to improve patient care within the service.

Aims: A recent MHRA alert highlighted a possible association between valproate use by men around conception and an increased risk of neurodevelopmental disorders in their children.

To ensure that 100% of male patients on valproate in the practice are informed about family planning risks associated with valproate use and have documented advice recorded in patient electronic record system (EMIS) within 2 months.

Methods: The cohort consisted of 22 male patients on valproate, identified using the EMIS system. These patients were targeted for the intervention to ensure compliance with the MHRA guidance on family planning risks.

The first intervention involved sending an Accurx text message to all 22 patients. outlining the potential risks associated with valproate use around conception, need for effective contraception for both partners, and encouraged patients to contact the practice if they were planning to start a family.

After 1.5 months, a follow-up intervention was conducted. All 22 patients were contacted by phone to verify whether they had received the text, assess their awareness of the MHRA guidance, and provide family planning advice if they were previously unaware. Phone calls were made on two separate occasions, spaced two weeks apart, to maximise the likelihood of reaching patients.

Results: Of the 22 patients, 18 were successfully contacted. Amongst these, 8 confirmed receiving the original text message, while 10 didn’t. During the phone calls, it was noted that 5 patients were already aware of the MHRA alert, 13 were unaware but were informed of the guidance during the call.

Patients were also given an opportunity to ask any further questions or express concerns. For those who required additional information, the option of a consultation with the practice pharmacist was offered. Despite repeated attempts, 4 patients could not be reached.

Conclusion: This QIP revealed significant gaps in patient awareness of valproate family planning risks and the challenges of engaging patients with automated messaging. Key reflections include: Challenges with Automated Texting; Improved Communication with Phone Calls; Limited Patient Engagement.

This QIP successfully raised awareness of an MHRA alert regarding valproate use among male patients in a GP practice. While the initial response to automated texts was poor, follow-up phone calls ensured that most patients were informed. The project underscored the importance of a multi-modal, sustained approach to patient education for sensitive topics like family planning.

Recommendations

Routine Medication Reviews.

Pharmacist-Led Discussions.

Enhanced Communication Strategies.

Practice-Wide Alerts.

Aims: The 2019–20 Community Pharmacy Quality Scheme audit concluded 34% of audited patients were unfamiliar with lithium toxicity symptoms, where 29% were unaware of how to prevent it, highlighting the gap in effective patient education. Our preliminary research revealed that 50% of medical professionals lacked confidence in providing lithium counselling with 41% being either unaware or unsure of how to counsel a patient if they had missed a dose. Therefore, we aim to tackle staff knowledge and improve abilities in lithium counselling to enhance patient safety and understanding, ultimately leading to fewer incidences of toxicity and harm.

Methods: An initial survey was conducted to assess healthcare professionals’ confidence in lithium counselling prior to the teaching sessions, identifying specific gaps in knowledge among staff. The Quality Improvement Project was implemented through two Plan-Do-Study-Act (PDSA) cycles:

PDSA Cycle 1 (19 attendees): A lecture-based teaching session using an online presentation was delivered, covering key information regarding lithium counselling. An improvement in knowledge was assessed using pre- and post-session quizzes, created using the information in the “Lithium Policy KMPT Handbook”.

PDSA Cycle 2 (6 attendees): An interactive OSCE-based teaching session was delivered to reinforce and apply the content from PDSA 1 via two clinical-based scenarios including discussion and feedback.

All teaching material was distributed to staff members, and the session was recorded for future training opportunities, accounting for standardised teaching methods.

Results: The baseline average score was 50%. Following the PDSA 1 session, this increased to 79%, demonstrating a statistically significant improvement (t = ×5.14, p<0.001). Following the PDSA 2 session, there was a slight decrease to 77%.

Key areas of knowledge that showed notable improvement after PDSA 1 included:

1 – Missed Dose Advice: χ² (1, N=37 =0.000154, p=0.05.

2 – Lithium use in pregnancy: χ² (1, N=37)=0.00056, p=0.05.

3 – Initiating lithium monitoring: χ² (1, N=37)=0.004238, p=0.05.

Direct comparison between post PDSA 1 and 2 is limited due to the lack of participant continuity.

Conclusion: After PDSA 1, a clear improvement in staff scores was observed. Despite showing a slight decrease in knowledge after PDSA 2, both teaching methods proved effective in improving lithium counselling knowledge from baseline.

We hypothesise that attending both sessions would lead to the greatest improvement; however, scheduling constraints prevented consistent attendance. Attempting to account for this, sessions were planned online. Upon reflection, recording and disseminating all teaching resources were vital in ensuring standardised training.

Aims: To enhance the quality of care for patients experiencing psychotic episodes during the perinatal period (antenatal and postnatal) by improving service pathways and management.

Methods: This was a retrospective study, in which existing care pathways for patients presenting with psychosis in perinatal period were reviewed, gaps identified and then solutions to improve standards were proposed. Out of 41 patients admitted to the local inpatient unit with psychosis in perinatal period between January 2022 and October 2024, 11 patients were selected as they met the criteria of diagnosis of perinatal psychosis. Data was collected and reviewed from electronic records and patients’ notes.

Data was assessed, whether the key elements for patients presenting with psychosis were documented in admission history, the management plans and the extent of involvement of perinatal team throughout different stages of their care.

Results: It was found that 90% of patients (10/11) were clerked on admission. In 63% patients (7/11) reasons of admission were documented, and 54.5% (6/11) having documentation about parity.

81.8% (9 of 11) had perinatal team involvement during admission, 45.45% (5 of 11) had discharge follow up with perinatal team, while 27.27 % (3 of 11) were discharged to other teams. Only 9% (1/11) were asked about perinatal family history, 81% (9/11) were not asked about perinatal family history while 1 patient had missing clerking documentation.

Conclusion: There were notable gaps picked up in clerking history especially perinatal family history, gestational age and parity, which are critical points in history taking in patients presenting with psychosis in perinatal period. While there is consistent involvement of perinatal team during admission, there seems to be lack of consistency in post-discharge engagement.

The data suggested more standardised clerking, and discharge planning process to ensure all element of care are covered. By implementing the proposed, we anticipate a positive impact on patient outcome, more cohesive multidisciplinary care and improved patient follow up leading to better quality care.

Aims: Trainee Council Meetings (TCMs) offer a dedicated time and place for trainees working in the Trust to highlight issues and raise concerns relating to their rotations.

Trainee engagement in these meetings has historically been variable. This project was developed with the aim of improving trainee engagement with TCMs. It is part of a larger ‘Raising Concerns’ Quality Improvement Project within the Trust.

Increase attendance at Trainee Council Meetings (TCMs) by Foundation, GP and Core Psychiatry Trainees.

Improve structure and organisation of Trainee Council Meetings.

Improve trainee access to records of meeting minutes.

Methods: Retrospective TCM attendance data was collected in Summer 2023. The only data available were numbers of attendees, not trainee grade. The following issues were identified:

TCMs sometimes took place in person and sometimes took place online (via Microsoft Teams). Attendance tended to be poorer for in-person meetings than those online.

There was no clear leadership structure within the Trainee Council.

There was lack of clarity over which representatives were responsible for planning and facilitating TCMs. This led to an unfair and unequal distribution of TCM workload.

The following change ideas were implemented from the respective dates:

July 2023 – It was agreed that TCMs would always take place online.

August 2023 – Development of two leadership roles within the Trainee Council: ‘Trainee Representative and Induction Co-ordinators’ and ‘SHO Inclusion Co-ordinators’. Planning and facilitation of TCMs was agreed as a responsibility to be shared amongst these representatives.

Development of a Meeting Proforma (see Appendix), clarifying actions to be taken by council leads before, during and after TCMs.

Attendance data were collected prospectively between September 2023 and March 2024. Data included numbers of trainees attending and trainee grade.

Results: Trainee attendances before change ideas:

December 2022 – 20

March 2023 – 9

June 2023 – 22

Trainee attendances after change ideas:

September 2023 – 38

November 2024 – 34

March 2024 – 36

Conclusion: Attendance data show that there has been an improvement in numbers of trainees attending Trainee Council Meetings following implementation of change ideas.

Attendance of trainees by grade was unknown prior to June 2023. The majority of attendees between September 2023 and March 2024 were Core Psychiatry trainees. Attendance by Foundation and GP trainees is low.

Aims: To develop and promote wellbeing amongst Resident doctors and embed this into the Core Trainee Committee (CTC).

Methods: This Quality improvement project was part of a response to Trainees’ wellbeing developed after noting the dissatisfaction of trainees with wellbeing in the 2024 GMC National training survey. It reported that over a fifth (21%) of trainees measured to be at high risk of burnout and over half (52%) described their work as emotionally exhausting to a very high or high degree.

Dr Sungum (wellbeing lead), devised the pathway using an internally generated traffic light system of the wellbeing department in the Trust and Deanery. Following this, some Core trainees trained as wellbeing activists to support their peers and created and distributed a wellbeing pathway and poster to that effect. We organised activities to improve wellbeing including monthly trainee socials and wellbeing lunch drop-ins. We created a Survey about wellbeing distributed amongst all Psychiatry trainees in the health board.

Results: 12 Psychiatry trainees were surveyed. 75% of respondents were aware of the wellbeing pathway we had created and found it useful and informative. 0% of respondents had used any resources from the wellbeing pathway. 83.3% of respondents found the trainee Socials beneficial to their wellbeing. They also gave feedback on how the wellbeing service can be improved for trainees. Below are some of their responses:

“When I started training there was no wellbeing talk. This initiative is fantastic. Keep up with the socials. Fundamentally, if the trainees felt more valued and cared for, wellbeing would certainly improve and reduce burnout.”

“For more trainees to know who to contact if struggling. But otherwise, good advertisement of resources. And socials have been a good way to meet more of my colleagues.”

“Having a dedicated time for informal discussion between colleagues as part of rotation transition – perhaps as part of the last Tuesday teaching session for 1 hour might be useful.”

Conclusion: Most Psychiatry trainees are aware of the wellbeing service but have not used it. Most respondents were keen on having more social activities as a way to improve their wellbeing. This Quality improvement project largely met its aim with room for further improvement.

Wellbeing is now embedded in governance as part of the CTC and is actively discussed with compassion in formal and non-formal settings.

Aims: Up-to-date and accurate diagnostic information is essential for many reasons including effective clinical management; however, this may not be the case for psychiatric patients seen across different healthcare settings. It was intended to explore the documentation of both psychiatric and physical diagnoses within the electronic case records (ECR), and their quality based on the character of International Classification of Diseases coding; and to update the information where appropriate.

Methods: Records of 114 consecutive patients attending outpatient clinics were studied. An initial audit of psychiatric and physical diagnoses was conducted; followed by updating these where additional information was available.

Results: The sample consisted of 65 (57.0%) female and 49 (43.0%) male patients, with a mean age of 41.3±13.6 and 37.4±12.9 years. The period in psychiatric services was less than one year in 20 (17.5%); between one and five years in 57 (50.0%) and more than five years in 37 (32.5%) patients. Comorbidity of psychiatric diagnoses was present in 39.5%; similarly, 51.8% had associated physical diagnoses, with 29.8% having more than one physical diagnosis.

Before the intervention, only 35 (30.7%) patients had psychiatric diagnoses available in the designated place in ECR, although diagnoses were available in 97.4% of cases elsewhere in the case record. In 83 (72.8%) patients additional psychiatric diagnoses could be entered. Pre- and post-project, the mean number of psychiatric diagnoses changed from 0.7±1.4 to 1.0±1.3 (p<0.001), and that for physical diagnoses were 0.3±0.9 and 1.1 ± 1.4 (p<0.001). The number of characters of ICD diagnoses also changed, such as three (1.8% v 4.4%), four (28.9% v 86.8%) and five (0.0% v 8.8%) respectively (p<0.01).

Initially, 15 (13.2%) patients had physical diagnoses; however, it was updated in 43 (37.7%) patients. In 28 (24.6%) patients physical diagnoses were taken from the GP records; the total number of diagnoses entered in this process was 55, with a mean of 0.5±1.1 per patient.

There was no difference between genders in the documentation of psychiatric or physical diagnoses initially; however, following updating, the mean number of psychiatric diagnoses for males (2.1 ± 1.6) was significantly more than for females (1.6±0.9; p<0.05).

Conclusion: A focused effort to review and document psychiatric and physical diagnoses appropriately can improve the quality of ECR and support patient care. This is especially relevant for patients being seen in different settings of primary and secondary care centres.

Aims: Advance care planning is a process of person-centred discussion between individuals and their care providers about future care preferences. Advance care planning discussions are relevant for those wishing to plan for their future care or those at increased risk of losing mental capacity, such as dementia patients or individuals with life-limiting illnesses. Aims were:

Improve advance care planning discussions on a specialist dementia unit.

Improve identifying patients who would benefit from an Advance Care Plan (ACP).

Offer all patients an initial ACP discussion.

Ensure patients with an estimated prognosis of <12 months have an ACP in place by discharge.

Improve ACP communication to acute hospitals and GPs.

Methods: Patient data was collected weekly from May 2024 until January 2025. 67 patients in total.

The Universal Care Plan (UCP) was chosen as a framework to document ACPs. The UCP is an NHS service that enables patients in London to have their care and support wishes digitally shared with healthcare professionals across the capital.

The Gold Standards Framework Proactive Identification Guidance was used to identify patients at risk of physical deterioration and prioritisation for ACPs. Prognostic coding and prioritisation for ACPs was reviewed daily with the MDT.

Staff underwent training on ACPs. More accessible ACP information was provided on the unit. The process of booking ACP discussions was refined, introducing a weekly ACP meeting slot (starting 23/07/24).

Results: Number of patients on the unit with an ACP increased between May 2024 and January 2025, from a low of 0% on 03/06/24 to a high of 53% on 12/12/24. Initial ACP discussions offered increased from 27% (20/05/24) to 93% (28/01/25). After introducing the weekly ACP slot, 41% slots were filled. 48% of dementia patients had an ACP by discharge. 50% patients with an estimated <12-month prognosis had an ACP by discharge.

By January 2025, 100% prognostic coding was communicated to the GP.

Conclusion: The weekly timeslot increased the number of ACPs. Improved identification of patients resulted in approximately half of dementia patients, and half of patients with a prognosis of months, having an ACP by discharge. Challenges included embedding ACP meetings into routine practice. Recommendations:

Gather feedback from patients and carers – case studies suggested ACP discussions were well received by carers and positively impacted patient care.

Continue the regular weekly ACP slot.

Provide more staff training.

Audit outputs of ACP discussions.

Aims: Ogura Ward is a psychiatric inpatient Clinical Decision Unit (CDU) which contains 20 rooms for male patients with acute psychiatric illnesses. These patients are frequently at high risk of self-harm. In a bid to minimise the risk of self-harm, Ogura ward contains two anti-ligature rooms designed to keep patients safe. Correct allocation of patients to these rooms is crucial for patient safety. However, gaps in staff awareness regarding the locations of these rooms and the patients assigned to them were identified, emphasising the need for targeted interventions.

This Quality Improvement Project (QIP) aims to improve staff awareness of the anti-ligature room locations and the patients assigned to each room. The project aims to achieve an 80% improvement in staff awareness over two months.

Methods: A Quality Improvement Project (QIP) was implemented using a Plan-Do-Study-Act (PDSA) cycle over two months. Initial staff consultations and surveys highlighted gaps in awareness, forming the basis for intervention design. Two interventions were introduced one week apart:

A daily updated poster displayed in the nursing station, identifying the anti-ligature rooms and patients allocated to these.

Structured reminders during multidisciplinary team (MDT) meetings.

After each intervention, a re-survey was conducted to evaluate its effectiveness before the next intervention.

Results: The first intervention (poster) resulted in 75% of staff correctly identifying the room locations and 65% identifying the patient allocations up from 23.53% and 41.17% respectively. The second intervention (MDT reminders) further improved awareness, with 88.2% of staff accurately identifying allocations. Staff communication ratings also improved, with 94.11% rating MDT communication as excellent or good, up from 35.29%. Despite progress, out-of-hours patient admissions posed challenges to maintaining up-to-date awareness. These findings emphasised the need for sustainable real-time solutions. Other challenges included ensuring consistency and sustainability of interventions.

Conclusion: This QIP successfully enhanced staff awareness and communication regarding anti-ligature room allocations, contributing to improved patient safety practices. The project is currently in its third cycle, focusing on integrating room allocation information into the RIO electronic system to enable real-time accessibility and sustain improvements. Future work will involve completing this integration as well as expanding the project to other wards within the Trust to assess the broader impact and applicability of these interventions.

Aims: The aim was to develop a strategy for mental health and learning disabilities in an acute and community trust in North Cumbria, in response to the CQC report “Assessment of mental health services in acute trusts programme” published in 2020. The strategy also needed to align with the trust vision, values and objectives while developing a clear but simple overview of what is required to improve mental health services within the trust for people with a wide range of mental health difficulties and learning disabilities. We also describe novel and innovative roles for psychiatrists as a new area of professional practice.

Methods: The trust appointed strategic and clinical leads, both consultant psychiatrists supported by a senior manager. We reviewed the latest government documents, NHS guidelines and college reports in relation to mental health priorities within an acute trust, reviewed the mental health service delivery requirements as set out by the CQC both nationally and by analysing the local CQC report. Existing services within the trust and partner organisations such as social care, other NHS trusts, primary care and the ICB were consulted.

Results: The strategy was developed and focused on 5 tactical arms:

Culture, kindness, inclusion and understanding.

Shared patients, partnership and policy.

NCIC innovations.

Integrated governance.

Organisation of roles.

Each arm has a concise description of what needs to be done to achieve our strategic aims with a set of key performance indicators to evaluate the trust’s performance in achieving the CQC requirements. The strategy has been underpinned by developing an oversight group to understand the strengths and areas needing improvement, thus informing the appropriate development of services and resource allocation. The strategy has been approved by the board within a year of appointing the team that were recruited to implement it.

Conclusion: We propose there is a professional leadership space that psychiatrists have not yet moved to occupy outside of mental health trusts. However, psychiatrists are in fact extremely well placed to contribute to the provision of mental health and learning disabilities in an acute trust given the background of medical and mental health training. The impact of the strategy now needs to be assessed to ensure that it delivers improved services.

Aims: The purpose of this project was to improve clinician’s understanding and adherence to prolactin monitoring guidelines among doctors, reducing unnecessary testing and ensuring appropriate management of hyperprolactinaemia in patients on antipsychotic medications.

Prolactin monitoring in patients on antipsychotic medications is crucial for detecting and managing potential side effects. However, inconsistent adherence to monitoring guidelines can lead to missed diagnoses, unnecessary testing, and suboptimal patient management, inappropriate cessation of antipsychotics, or unnecessary addition of aripiprazole. This quality improvement project aimed to assess and improve clinicians’ knowledge and measure the adherence to prolactin monitoring guidelines across three acute psychiatric wards in a North London Hospital.

Methods: A retrospective audit examining prolactin monitoring practices of patient records from June–July 2024 was conducted across three inpatient wards in a North London Hospital. Key metrics included frequency of symptom inquiry, appropriateness of testing, and adherence to management guidelines. Following the audit, an educational intervention was implemented at North London Mental Health Trust Academic programme, consisting of a presentation and pre/post-teaching surveys to assess knowledge improvement. Flowcharts summarising the guidelines were subsequently displayed in doctors’ offices.

Results: The audit revealed low rates of symptom inquiry (7.4% in Sunflower, 6.25% in Tulip, 21.1% in Daisy) and high rates of unnecessary testing (44.4% in Sunflower, 81.25% in Tulip, 73.7% in Daisy) among patients on antipsychotics. Guideline adherence for managing raised prolactin levels was poor across all wards. The pre-teaching survey (n=37) demonstrated significant knowledge gaps, average 45% correct responses, particularly regarding age-specific monitoring and indications for testing. Post-intervention, a marked improvement in knowledge was observed across all domains in the post-teaching survey (n=16) with an average of 84% correct responses. For instance, correct responses regarding age-specific monitoring improved from 22% to 68.75% for women and from 11% to 81.25% for men.

Conclusion: This quality improvement project identified significant gaps in clinicians’ knowledge and adherence to prolactin monitoring guidelines. The educational intervention demonstrated substantial improvements in clinicians’ understanding of appropriate monitoring practices. Ongoing efforts, including the display of guideline flowcharts and plans for reassessment, aim to sustain these improvements. Future work will focus on measuring long-term adherence to guidelines and its impact on patient outcomes and resource utilisation.

Aims: Educating patients about metabolic side effects.

Empowering patients with knowledge and skills to make informed lifestyle choices.

Implementing personalised lifestyle interventions to improve metabolic health parameters.

Monitoring progress to facilitate long-term adherence to healthy behaviours.

Methods: Patients between 18–65 years.

Symptoms of metabolic syndrome i.e. high blood pressure, low HDL, truncal obesity, high triglycerides, impaired fasting glucose.

Patients currently/historically on antipsychotic medication.

Patients who have at least a year left in the service were included in the pilot.

Relative stability in mental health i.e. ability to engage with physical health appointments.

Results: The pilot concluded that patients benefited from tailored lifestyle interventions, giving them a sense of purpose and accountability.

There were significant changes in waist/circumference ratio; with noted improvement. Waist mean change = −5 cm (−6%); Waist:height mean change =−0.03 (−6%).

There were significant changes in weight: 5 individuals lost weight and improved their BMI; 2 individuals improved from overweight >normal.

There were no significant changes in biochemical markers.

A larger sample is required for a longer duration to study the impact of lifestyle interventions.

Conclusion: Small sample size – risk of bias, limited generalizability. Measurements for waist circumference might be prone to error as there is variation in the method of measurement i.e. over or under clothing. Blood results were inconclusive, perhaps the focus of the second phase should be waist circumference since there was marked change and measurable.

Clients would benefit from maintaining a food/mood diary and attending a briefing group at the start of the study to understand the basic principles of nutrition and the digestion process.

Aims: Psychiatric patients on elderly psychiatric wards often have multiple physical comorbidities and there is also a clear link between mental and physical health. Trainees on old age psychiatry wards, both during the day and on call, have to manage acute and routine medical conditions. We wanted to evaluate how confident trainees find managing acute and routine medical conditions on the psychiatry wards, and whether they know where to gain advice from.

Methods: A survey via googleforms was designed to assess confidence in managing medical conditions in old age psychiatry patients, whether they often require advice, and if they know who to contact. We also asked which conditions they felt they required more guidance on.

Results: 9 responses were collected. 66.7% of trainees felt quite confident in managing day to day medical conditions, 22.2% did not feel confident at all and 11.1% were neutral. In managing medical emergencies, 11.1% felt very confident, and 22.2% felt quite confident, however 33.3% felt neutral, 11.1% felt only slightly confident and 22.2% felt not confident at all.

There was a range in responses to whether trainees tend to rely on advice from others, as opposed to managing medical conditions themselves. With 22.2% disagreeing with the statement, 33.3% neither agree nor disagree, 22.2% agreeing and 11.1% strongly agreeing.

Based upon these results, a brief guide was created with management tips of common medical problems and links to useful guidelines. A second survey was then sent out to assess usefulness.

80% of respondents felt it was very useful in both emergencies and day to day conditions, and 20% felt it was useful. 80% felt it contained information they did not already know and 100% felt it was a useful addition to the trainee handbook and it covered all medical conditions they wanted it to.

Conclusion: There was a range in confidence levels in managing medical conditions, however some trainees reported not feeling confident at all, or only slightly confident. Based upon these results, a brief guide to management of common medical conditions was created, for both day to day and routine medical conditions, and links to useful guidance. This was created by trainees, with advice and information provided by the ward GP. Trainees found this handbook very useful.

Aims: This audit aims to ascertain the rate of Did Not Attends (DNAs) in the St John’s Wood PCN, North Westminster CMHT between 01 March 2024 to 31 May 2024 and to evaluate the rate of DNAs following the implementation of SMS reminders one working day prior to a scheduled appointment between 01 June 2024 and 31 August 2024.

Methods: The rate of DNAs for outpatient appointments booked between 01 March 2024 to 31 May 2024 were reviewed by scoring the number of DNAs out of the total number of appointments booked. The percentage was calculated and tabulated using Microsoft Excel for simple statistical analysis.

SMS reminders were sent one working day prior to a scheduled appointment for appointments booked from 01 June 2024 onwards. A re-audit of the rate of DNAs was conducted for the period 01 June 2024 to 31 August 2024 and the results were presented to the Multidisciplinary Team.

Results: The data collected reflects an overall mean improvement of 33.3% in the rate of DNAs following the implementation of SMS reminders one working day prior to a scheduled appointment. The mean percentage of DNAs decreased from 7.5 % to 5.0% following the implementation of SMS reminders one working day before a scheduled appointment.

Conclusion: This audit reflects an overall improvement of 33.3% in the rate of DNAs by successfully reducing the rate of DNAs from 8.3% (highest) to 4.1% (lowest) with a mean improvement of 2.5%. The intervention is deemed successful and feasible for long-term implementation within the service. We recommend a re-audit 12 months post intervention to evaluate its sustained effectiveness within the service.

Aims: Valproate is a commonly prescribed drug in neurology and psychiatry, licensed for epilepsy as an anticonvulsant and in bipolar disorder as a mood stabiliser. Valproate is highly teratogenic with evidence suggesting that use in pregnancy leads to neurodevelopmental disorders (approximately 30–40% risk) and congenital malformations (approximately 10% risk). Consequently valproate must not be used in females of childbearing age unless conditions of pregnancy prevention programme (PPP) are met.

To aid the monitoring of risk, the Annual Risk Acknowledgment (ARA) form for valproate forms a key part of the UK’s valproate pregnancy prevention programme. It documents the patient’s awareness of risk, reinforces the PPP, promotes informed decision making and vitally ensures compliance monitoring to ensure prescribers are following national guidelines.

To measure compliance with completion of the ARA form for all adult female patients (18–65) prescribed valproate within our local mental health outpatient and inpatient services.

To devise digital solutions for record keeping and reminders with the aim to support clinicians to complete the forms in a thorough and timely manner.

Methods: With support from pharmacy we retrieved a list of female patients prescribed valproate in our locality, which served as a central valproate register. We examined patient records to determine whether an ARA form was on their records and if the form was completed and up to date. We then produced a list of patients who required renewal/completion of the form.

The team met with Information technology system provider (RIO) to discuss creation of a digital central valproate register and using digital clinical reminders on patient’s records to notify clinicians when the form was due for renewal.

Results: Reminders were sent to relevant clinicians/teams, requesting them to complete the required ARA form at earliest opportunity. The data from the central valproate register was shared with the RIO team who agreed to transfer this data to the electronic records intervention list in order to create digital version. They then agreed to create a valproate tab in patient’s records, and link the ARA form to the tab. This link up will automatically act as trigger to warn clinicians that the ARA form is due for completion.

Conclusion: This project has created a central database for local service users who are on valproate. By doing so it has facilitated the tracking of ARA forms for the clinicians. Creation of automatic reminders will further help clinicians in completing the required form in timely manner.

Aims: The 2023 GMC national trainee survey revealed that 33% of secondary care trainers reported that their trainees’ education and training were adversely affected because rota gaps aren’t always dealt with appropriately. This project aimed to improve locum rates within the South West London and St George’s Mental Health NHS Trust (SWLSTG) to address these issues and enhance training conditions.

Methods: A Freedom of Information (FOI) request was sent to all London mental health trusts to gather data on locum rates at core trainee and registrar levels, escalation policies, and definitions of social and unsocial hours. The data was compiled and compared in a spreadsheet, then presented at the Medical Out of Hours Working Group (MOOHWG) meeting. A new policy was developed to amend out-of-hours pay for doctors based on the findings. This was presented in an executive meeting where it was approved, with changes implemented in August 2024. The process occurred from November 2023–July 2024.

Results: The FOI responses revealed that SWLSTG offered less favourable locum rates compared with other London mental health trusts. To bring SWLSTG in line with the local trusts, several key changes were made. The definition of unsocial hours was updated from 9pm–9:30am to the London consensus definition of 7pm–9:30 am on weekdays, as well as all day during weekends and bank holidays. An escalation policy was introduced for shifts first announced with less than 48 hours’ notice, offering a 20% rate increase. Locum rates were also revised: CT1/2 social rate was increased from £40 to £45 per hour, and the unsocial rate from £45 to £54 per hour. CT3 rates were differentiated from CT1/2, with the social rate rising from £40 to £49.25 per hour, and the unsocial rate from £45 to £59.10 per hour. Additionally, the ST4–6 social rate was raised from £45 to £49.25 per hour, and the unsocial rate from £55 to £59.10 per hour.

Conclusion: The changes to locum rates and the introduction of an escalation policy at SWLSTG have successfully brought the trust in line with other London mental health trusts. These improvements are expected to reduce the negative impact of rota gaps on trainee education and training, helping to maintain high-quality service delivery and ensure more favourable working conditions for resident doctors. Further evaluation is recommended to assess the long-term impact of these changes on both trainee satisfaction and patient care.

Aims: Project ‘BANGED’, a Quality Improvement Project (QIP) aimed to enhance confidence, consistency, and clarity, when completing post headbanging reviews (PHBR).

The world of psychiatry is often the first-time (and perhaps only time) resident doctors (RDs) are exposed to such behaviour thus request. This can be daunting, often inducing a ‘CT head reflex reaction’.

A tool to strike balance between true neurology vs over medicalisation seemed pressing. Thus, the bedside tool ‘BANGED’ was created. A guiding acronym for RDs to use, designed for inpatient settings. Aimed at the general adult population, however, has relevance to other areas such as Intellectual Disability.

QIP carried out at Humber Teaching NHS Foundation Trust (HTNFT).

‘BANGED’

Each letter represents key areas of focus for PHBRs and is as follows:

B – bruising, bumps (swelling), breakage of skin, bleeding (? active).

A – awareness – any LOC, GCS, awareness of triggers – reason for head banging if known (any ways of reducing this).

N – Neurological deficits – any red flags for head injury & Nausea/vomiting, are neurological observations required? Nursing engagements.

G – gross (motor) movements, gait.

E – eyes (pupils) equal and reactive to light, accommodation, any diplopia.

D – dizziness, drowsiness – don’t forget glucose (if dizzy and oral intake concerns).

Methods: 2024 timeline.

August: Created the acronym ‘BANGED’ following brief narrative review, discussion amongst psychiatry trainees and own experience. Showcased tool via integration of ‘BANGED’ into poster and presentation.

September: Gathered baseline data via pre-intervention questionnaire – sent out to all HTNFT psychiatry RDs – initial confidence, understanding, applicability of tool. Presented tool in teaching session. Distributed poster and displayed in staff facing areas on HTNFT inpatient units.

November: Shared results of pre-intervention questionnaire. Re-shared tool. Post Intervention questionnaire – gathered feedback regarding tool implementation into practice.

Results: Pre-Intervention Questionnaire:

Delivered face to face.

31 doctors responded of mixed grades.

Around half had never completed a PHBR (coincided with beginning of rotation).

19.4% selected ‘Not confident at all’ with such task.

93.5% were unaware of any helpful tools.

100% answered yes to ‘Would a tool such as an acronym help your approach?’.

Post-Intervention Questionnaire:

Delivered online.

9 doctors responded of mixed grades.

Most used the tool.

100% would recommend.

Comments: easy to use, relevant to clinical practice, clever acronym, improved confidence.

Conclusion: PHBRs remain a daunting yet apparent task for psychiatry RDs. The bedside tool ‘BANGED’ shows promise for improving approach, by offering guidance for key areas of focus.

Future practice – further cycles required, delivered in person – better response rate.

Aims: This quality improvement project aims to investigate the quality of completed Section 5(2) forms in a large, acute NHS hospital in England. It seeks to establish a current data baseline and identify common errors. The statutory section 5(2) form can be confusing for those who are unfamiliar with it, especially the section requiring correct deletion of options to identify the completing doctor’s status. Incorrectly completed Section 5(2) forms may later need rectification or can lead to the invalid detention of a patient, in which case the patient may be able to claim financial compensation.

Methods: The most recent twenty (n=20) Section 5(2) forms across adult and paediatric medicine from November to December 2024 were analysed against a created proforma containing twelve criteria needed to correctly complete the form and provide rationale for detention.

Results: On average Section 5(2) forms were 84% correctly completed with a total of 202/240 criteria met. Of the twenty forms surveyed, 100% were legally valid. Furthermore, 100% recorded diagnoses, symptoms, or behaviours suggestive of a mental health disorder and were legible, signed, and dated by the relevant parties. 70% identified risks to the patient or others if the patient were not detained and 55% contained correctly deleted phrases to reflect the status of Registered Medical Practitioner (RMP), Approved Clinician (AC) or Nominee. However, the majority (55%) contained medical abbreviations and only 40% indicated detention was necessary to allow a Mental Health Act Assessment (MHAA) to occur.

Conclusion: Overall Section 5(2) forms are completed well by doctors in this survey with all citing evidence of a mental health condition and the majority including an assessment of risk. Increased physician education and awareness of key information may increase the documentation of risks, the need for a MHAA and promote the avoidance of abbreviations which can cause errors. The ongoing work reviewing the new Mental Health Act could consider simplifying the pre-determined options, which may increase the correct completion of the RMP/AC/Nominee status section. Meanwhile, doctors may benefit from an aid with clear examples of the correctly deleted phrases being issued alongside the Section 5(2) forms. The surveyed hospital is currently revising Section 5(2) guidelines and preparing example templates for doctors to use. After allowing time for the implemented changes to take effect this project will aim to re-audit and measure impacts.

Aims: Berkshire Healthcare NHS Foundation Trust utilises a Quality Management Improvement System (QMIS) which facilitates a culture of continuous improvement across the Trust. This system includes regular “Huddles” where all staff are encouraged to participate in identifying areas for improvement. Through a Huddle within the Berkshire Child and Adolescent Mental Health Service (CAMHS) Rapid Response Team, concerns were raised about the variable quality of assessments for children and adolescents in crisis. This project was designed to address this concern.

Methods: We designed a multifaceted approach to accurately map out the scale of the issue from multiple perspectives to help identify training needs and direct future interventions involving:

1. Designing a quality framework and rating system for reviewing assessments looking at domains agreed by the senior multidisciplinary team (psychiatry, management, psychology and nursing) and informed by existing assessment guidelines. Domains agreed:

Comprehensiveness.

Accuracy and clarity.

Formulation.

Sensitivity and cultural competence.

Document quality.

Rated from 1–5 (1 – poor, 2 – needs improvement, 3 – satisfactory, 4 – good and 5 – excellent).

2. A rating exercise using the framework is to be completed by all assessing clinicians split into two groups (for anonymity), facilitated by senior clinicians. A total of 36 assessments (18 per group) completed in the preceding three months are to be reviewed.

3. Finally, the systemic family therapist would arrange to observe all assessing clinicians in at least one initial assessment to identify and note any other areas for improvement or concern within the assessment itself.

Following the above, information will be collated and analysed to identify specific areas of need within the team’s assessments.

Results: We describe a comprehensive approach to review assessment quality within teams, and which encourages the utilisation of multidisciplinary expertise. The framework can be adapted to the needs and multidisciplinary composition of other teams. The crucial aspect is multidisciplinary collaboration – to ensure a holistic assessment of quality.

Involving assessing clinicians in rating assessments is a strength as it allows their perspectives to be included, and simultaneously creates a learning opportunity by attuning them to what is expected of an assessment.

We have also demonstrated the value of having quality improvement systems embedded within the standard work of a team which shares out responsibility and accountability and encourages wider participation.

Conclusion: The quality improvement project methodology described can be used by other teams to map out current assessment quality and identify specific target areas for improvement. Further work might include co-production and external validation of our rating guide.